What is IBS?
A lot of people come in to my office and say they have been diagnosed with "IBS" or Irritable Bowel Syndrome. But what, exactly does that mean?
Technically, it usually means abdominal pain with dysfunctional bowels. There is no specific cause as it is usually due to multiple reasons (stress, infection, other bowel disease and more).
There can be 4 different types (1):
- IBS-C - constipation dominant (more than 25% of the time)
- IBS-D - diarrhea dominant (more than 25% of the time)
- IBS-M - mixed (hard/lumpy up to 25% of the time and loose/watery up to 25% of the time)
- Unspecified IBS - does not meet any of the above criteria
What are the Symptoms?
- constipation and/or diarrhea (can be both or alternating - see above)
- uncomfortable gas and bloating
- abdominal pain and cramping that is often relieved by having a bowel movement
- cramping and diarrhea associated with stress or "nervous stomach"
Fortunately, this diagnosis usually means there isn't much physical damage like you would find in the often confused Inflammatory Bowel Disease (IBD), otherwise known as Crohn's Disease and Ulcerative Colitis.
So that means the prognosis is good and risk of long-term complications are low.
But that doesn't mean the person suffering from it doesn't feel like damage is being made, just ask anyone having an IBS flare.
Many people with IBS also suffer from depression and anxiety because they aren't able to leave the house, or they have to know where all the bathrooms are when they do leave the house, so it can be a vicious cycle.
Is there testing available?
There is not a specific test used to diagnose IBS, but depending on how severe the symptoms are, some doctors may:
- run inflammatory markers in blood (to check for level of inflammation)
- check for anemia in the blood (loss of iron if there is bleeding)
- perform a sigmoidoscopy or colonoscopy to check for ulcers, polyps or other lesions
- screen for celiac disease via blood and/or biopsy
- take an abdominal x-ray to check for obstruction
- test for food allergies (blood is better than skin, but elimination diet is better than blood)
What about treatment?
Conventional medications offered to IBS patients can range from fiber, laxatives and anti-diarrheals to anti-anxiety and anti-depressant medications.
The good news: diet and lifestyle can help (especially with prevention)
- diet is essential and the first thing to do is to work on an elimination diet to find out what specific foods may be bothering you
- dairy (lactose), caffeine and fructose are common culprits
- probiotics can be helpful, especially Bifidobacterium infantitis (2)
- meditation and mindfulness can help to significantly reduce anxiety, a common trigger
- routine (mostly with eating and sleeping) is also very important and can affect stress response
But what if treatment doesn't work?
Another condition we are learning about that we are finding in a LOT of IBS patients is a condition called Small Intestinal Bacterial Overgrowth (SIBO).
According to recent research (3), there is an increased risk of SIBO in those who:
- developed IBS after an infection (postinfectious IBS)
- feel better on antibiotics and then relapse
- feel worse after taking probiotics with prebiotics in them such as FOS and inulin
- experience more constipation even with more dietary fiber
- have celiac disease (severe gluten allergy) yet don't feel better avoiding gluten products
- developed IBS (constipated-type) after taking opioid medications (narcotics/painkillers)
- have low iron in the blood (anemia) with no other apparent cause
SIBO testing and treatment is fairly new, but more and more doctors and gastroenterologists are becoming aware of it, especially naturopathic physicians and functional or integrative physicians.
Dr. Allison Siebecker, cofounder and medical director of the SIBO Center for Digestive Health in Portland, Oregon, has a wonderful website dedicated to educating both professionals and the public on the latest research on SIBO diagnosis and treatment.
For more information on SIBO (designed for both practitioners and the public), please join us for the SIBO Symposium in June 2015*:
- Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders. Gasteroenterology. 2006;130:1480-1491 (erratum in: Gastroenterology. 2006;131:688)
- Brenner DM, Moeller MJ, Chey WD, et al. The utility of probiotics in the treatment of irritable bowel syndrome: a systematic review. Am J Gastroenterol. 2009;104:1033-1049.
- Sandberg-Lewis S and Siebecker A. SIBO: Dysbiosis has a new name. Townsend Letter. Feb/Mar 2015. http://www.townsendletter.com/FebMarch2015/sibo0215.html.
*Whole Health Starts Today is a proud affiliate of NCNM continuing education programs